Joyce Pennington

Joyce Pennington, 62, with her dog, Honey, in her home in Midlothian , worries about what will happen after she is cut off from the state's prescription coverage on Sept. 1. “I know everybody’s hurting, and I don’t like to ask for help,” she says. “But now, it seems like I have nothing.” (Zbigniew Bzdak/Chicago Tribune)

Joyce Pennington opened a letter from the state recently and got some unexpected news: At the end of this month, she will be dropped from an Illinois program that helps pay for prescription medications.

The 62-year-old Midlothian woman, who has severe lung and heart disease, broke into tears. "I thought, wait a minute, I've worked my whole life and now that I need some help they're treating me like this?" she said.

Nearly 43,000 low-income seniors and people with disabilities are finding themselves in similar straits as they learn they no longer qualify for Illinois Cares Rx, a popular program whose funding was slashed in half, to $53.7 million from $107.4 million, in the new state budget.

They represent residents who are deeply vulnerable as the economy flounders and the state pulls in the reins on spending: people with limited incomes who aren't among the poorest of the poor but who rely on some aid to meet living expenses they wouldn't otherwise be able to afford. Many are afraid that state and federal budget crises will prompt lawmakers to continue to cut programs that provide medical support.

Illinois Cares Rx is a lifeline for these individuals, filling in expensive gaps in Medicare prescription coverage for some, covering Medicare drug plan premiums and co-payments for others, and subsidizing the cost of medicine for everyone in the program.

With reduced funding, the state has narrowed the ranks of people who are eligible for Illinois Cares Rx to those earning no more than 200 percent of the federal poverty level; previously, people with incomes up to 240 percent of this standard qualified. For an individual, the new threshold for eligibility is now $21,780, down from $27,610.

The change will take effect Sept. 1; at that point about 173,500 people will remain on Illinois Cares Rx and face higher co-payments for prescriptions — in some cases, double the amount they were previously paying.

Hit even harder will be tens of thousands of vulnerable seniors and people with disabilities who are being eliminated from the program and who have to scramble to come up with alternative ways of paying for their medicine. Many are distraught and overwhelmed by that prospect.

Pennington was one of the few willing to speak openly about the hardship she faces.

She takes 14 medicines for her various ailments. The cost of filling most of those prescriptions will triple when Pennington leaves Illinois Cares Rx, and one will jump to $42 a month, up from $6.30 a month. Where she'll get the money is unclear. Pennington said she already owes $900 to the company that delivers her oxygen supplies and hundreds more to the hospital where she goes when her lung or heart problems flare up.

"I know everybody's hurting, and I don't like to ask for help," this grandmother said. "But now, it seems like I have nothing."

The situation is causing tremendous "fear and anxiety," as well as significant confusion, said Terri Gendel, director of benefits and advocacy for AgeOptions, the area agency on aging for suburban Cook County. "Some people are panicked, to the point of almost being hysterical. Others just say, 'I've been in this program for years so it must be a mistake.' They're in denial."

That's a problem because what people losing Illinois Cares Rx coverage need to do, above all else, is "come up with a plan" for dealing with their medicine needs, Gendel said.

Those being forced to leave the program fall, broadly, into two groups. The first consists largely of seniors and people with serious disabilities enrolled in Medicare who have prescription coverage through Medicare drug plans or managed care-style Medicare Advantage plans. In their case, Illinois Cares Rx "wrapped around" the Medicare plans, covering costs that consumers are required to pay out of pocket such as premiums, deductibles and co-payments.

Those can be considerable, with monthly Medicare drug plan premiums of $30, on average, and monthly co-payments for brand-name drugs starting at $38.25 and going as high as $91.

Pennington falls into this category: Despite her age, she qualifies for Medicare coverage and has a Medicare drug plan because she's permanently disabled and enrolled in Social Security's disability program.

Then there's the infamous "doughnut hole," a gap in Medicare drug plan coverage that opens up when an individual buys $2,840 worth of medicine in a year. (The amount will be slightly different next year.) Some relief is available to seniors, as medication charges to those in the doughnut hole have been reduced by 50 percent this year. Even so, the costs can be considerable, which is why Illinois Cares Rx aid to people who find themselves in the Medicare doughnut hole is so helpful.

For this group, which has Medicare coverage, the most important immediate advice is "pay your monthly (drug plan) premium, because if you don't, you could lose your Medicare drug benefits," said Jim Parker, deputy administrator for medical programs at the Illinois Department of Healthcare and Family Services.

That's going to be a hardship for John Prykop, 80, and his wife, Helen, 73, who between them take eight drugs for heart disease, high cholesterol, vertigo, emphysema, rheumatoid arthritis and thyroid disease. The Hometown couple's income is $30,600 a year, just slightly above the new eligibility limits for Illinois Cares Rx.